全麻联合罗哌卡因硬膜外输注对胸乳入路甲状腺切除患者皮质醇的影响

Effects of general anesthesia combined with continuous epidural infusion of ropivacaine on concentration of plasma cortisol in patients of endoscopic thyroidectomy via breast approach

目的观察全麻联合罗哌卡因硬膜外输注对胸乳入路甲状腺切除患者血浆皮质醇的影响。方法 40例甲状腺切除患者随机分2组,每组20例:A组患者全凭静脉麻醉;B组患者全麻之前行T4-5硬膜外置管(0.1%罗哌卡因输注2 ml/h)。记录麻醉前(T0)、插管后5 min(T1)、切皮后60 min(T2)、拔管后5 min(T3)MAP、HR、Cor变化;术后6 h(T4)、12 h(T5)、以及24 h(T6)视觉模拟评分(VAS),术中丙泊酚、瑞芬太尼用量,拔管时间及镇痛泵按压(PCA)次数。结果与T0比较,两组患者T1时MAP、HR降低,T2、T3时HR降低,Cor增高,B组患者MAP降低(P<0.05);与A组比较,B组患者T1时MAP、HR降低,T2、T3时Cor降低(P<0.05);A组患者T5时VAS评分比T4增高(P<0.05);两组患者T6时VAS评分较T5降低(P<0.05)。与A组比较,B组患者T5时VAS评分降低(P<0.05),术中丙泊酚、瑞芬太尼用量,拔管时间以及镇痛泵按压次数降低(P<0.05)。结论全麻联合0.1%罗哌卡因硬膜外输注对胸乳入路甲状腺切除患者可良好控制术中应激和术后疼痛,降低麻醉药物需求。

Objective To investigate the effects of general anesthesia combined with continuous epidural infusion of 0.1% ropivacaine on concentration of plasma cortisol in patients of endoscopic thyroidec-tomy via breast approach. Methods Forty cases undergoing endoscopic thyroidectomy were randomly divided into 2 groups（20 in each group）. Patients in Group A were under total intravenous anesthesia. Before in-duction, patients in Group B were inserted the epidural catheter followed with continuous infusion of 0.1%ropivacaine（2 ml/h）. MAP, HR, Cor changes of all patients were recorded before anesthesia（T0）, 5 min after intubation（T1）, 60 min after incision（T2）, 5 min after extubation（T3）. VAS were recorded 6 h（T4）, 12 h（T5）,and 24 h（T6） after the operation. Intraoperative dosage of propofol and remifentanil, extubation time and bo-lus times of postoperative patient-controlled analgesia were recorded. Results Compared with T0, MAP and HR of all patients at T1 and HR at T2 and T3reduced, while Cor increased; MAP of patients in Group B were decreased（P〈0.05）. Compared with Group A, MAP and HR at T1 and Cor at T2 and T3in Group B decreased（P〈0.05）. Compared with T4, VAS of patients in Group A at T5increased（P〈0.05）; compared with T5,VAS of all patients at T6decreased（P〈0.05）. Compared with group A, VAS of patients in Group B at T5decreased（P〈0.05）, dosage of propofol and remifentanil, extubation time and bolus times of PCA were de-creased（P〈0.05）. Conclusion General anesthesia combined with continuous epidural infusion of 0.1%ropivacaine in patients of endoscopic thyroidectomy via breast approach can improve efficacy of intraopera-tive stress and postoperative analgesia, and reduce the demand of anesthetic drug.